Stupor and Coma - Rothrock Flashcards
What does a decreased LOC imply?
diffuse hemispheric disorder
disorder afflicting the ARAS (ascending reticular activating system)
OR
disorder affecting both
If the LOC far out of proportion to the focal signs, then the issue is….
extracerebral
If the focal signs are far out of proportion to the decrease in LOC, then the issue is…
intracerebral
What must you do in physical exam to check for intracerebellar hemorrhage?
get them out of bed
All intracerebral hemorrhages will (blank) within the first few hours and the pt will deteriorate clinically
expand
Intracerebellar hemorrhage runs what serious risk?
tonsilar hernation through foramen magnum
When do you get focal signs from an SAH?
when it acutely extends into the brain parenchyma or the pt subacutely suffers vasospasm and ischemic stroke
What is a subhyaloid hemorrhage?
bleeding into the eye from the increased pressure from an SAH
What are some of the clinical signs of an SAH?
subhyaloid hemorrhage
Papilledema
Cushing’s sign
What is Cushing’s sign?
Irregular respirations (impaired brainstem)
bradycardia
hypertension
what signs would point you towards hepatic encephalopathy?
Hx of EtOH abuse low BP even when supine confusion stool positive for blood low Hct normal CT or diffuse cerebral and cerebellar atrophy
What things cause reversible brain death?
barbiturate or hypothermia
In the absence of reversible brain death, the absence of pupillary light response indicates…..
virtually 0% chance of meaningful neurologic recovery
T/F: a patient can remain comatose and have neurologic improvement
true
What is the prognosis of neurologic deterioration in a comatose patient?
very poor prognosis
